Initial treatment for HIV infection with an efavirenz-containing antiretroviral regimen doubles a patient's risk for suicidal thoughts, attempts, or completion, according to an article being published in Annals of Internal Medicine.

Efavirenz is a common and highly effective component of antiretroviral therapy for HIV infection that has been associated with central nervous system side effects, including suicide. But because there has been no clear evidence of association between efavirenz and suicide, psychiatric history has not excluded patients from efavirenz treatment. Given the widespread use of efavirenz and uncertainty about its relationship to suicide, researchers sought to compare the hazard of suicidality between adults assigned to an efavirenz-containing antiretroviral regimen (n=3,241) versus those on an efavirenz-free regimen (n=2,091) for initial treatment of HIV. Suicidality was defined as suicidal ideation, attempted suicide, or completed suicide.

The researchers found that patients taking efavirenz had twice the risk of suicidality compared to patients not taking efavirenz. In addition, eight of nine completed suicides during the trial were in the efavirenz group.

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